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ADVANCED ABDOMINAL MALIGNANCIES

Patients with intraabdominal cancers are often those who have recurrent disease or those who have late presentations because these tumours are deep seated. While the prognosis worsens with recurrence or late presentation, there are situations where surgical salvage is possible. Many factors need to be considered including:

  1. Whether there is distant spread outside the abdominal cavity to the lungs, brain etc
  2. Invasion of adjacent critical structures e.g blood supply to the length of the small intestine
  3. The biological behavior of the tumour ie rapidity of the return of disease, the number of lymph nodes involved radiologically

Careful consideration of these factors and others will help determine the possibility of surgical resection. If surgical salvage is possible with either complete removal of the disease or maximal debulking of disease, chemotherapy and radiation can be added as adjuvant treatment for additional control of disease.

Case illustration:
A 50 year old man with local recurrence after the removal of right kidney for aggressive squamous carcinoma. The tumour had extended beyond the tumour bed to the right diaphragm and right liver. The local recurrence site was removed including part of the diaphragm and the liver. Reconstruction to cover the defect was achieved with a nylon mesh and abdominal muscle flap (Fig 1 to 6). The patient remains disease free 7 years after surgical salvage.

About Doctor

Prof Soo is a senior surgical oncologist specialising in Head & Neck oncology and complex abdominal and soft tissue tumours. In caring for each patient, he brings more than 40 years of experience in the public sector of treating and managing both local and international patients who presented with cancers of all stages and from all walks of life.

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